HYPERTENSION MAY BE TRANSPLANTED WITH THE KIDNEY IN HUMANS - A LONG-TERM HISTORICAL PROSPECTIVE FOLLOW-UP OF RECIPIENTS GRAFTED WITH KIDNEYS COMING FROM DONORS WITH OR WITHOUT HYPERTENSION IN THEIR FAMILIES

In several genetic hypertensive rat strains, transplantation studies h ave established that the kidney carries at least a portion of the gene tic message for hypertension. In man it has, of course, been more diff icult to obtain clearcut results. This historical prospective observat ional study, double-blinded for knowledge of donors' and recipients' f amiliarities for hypertension, concerns 85 transplanted patients, not treated with cyclosporine and with stable renal function, followed up for an average of 8 yr. Both the donors' and the recipients' families were carefully characterized for presence or absence of hypertension. After transplantation, in recipients without hypertension in their own families, a kidney coming from a ''hypertensive'' family determines l ess withdrawal and more introduction of antihypertensive therapy (AHT) than a kidney from a ''normotensive'' family (odds ratio for AHT intr oduction 5.0, confidence interval, 1.4 to 17.8; P = 0.017). In recipie nts with familial hypertension, the origin of the kidney does not infl uence the prevalence of hypertension after transplantation. More detai led analyses show that, in recipients without familial hypertension, t he transplantation of a ''hypertensive'' kidney determines a tenfold l arger increase in the requirement of antihypertensive therapy than the transplantation of a ''normotensive'' kidney, to obtain a similar blo od pressure control (P = 0.003). This result is confirmed by the analy sis of time-profile trends for antihypertensive therapy, adjusted for missing data, in the most clinically stable period (2nd to 10th yr aft er transplantation). The transmission of familial hypertension with th e kidney is thus seen only in recipients coming from ''normotensive'' families, because familiarity for hypertension blunts the effect of a ''hypertensive'' kidney.